Iron Deficiency Anemia

Introduction

A lower-than-normal amount of iron in blood serum results in decreased formation
of hemoglobin and a decreased ability for the blood to carry oxygen. Iron stores are
typically depleted first, followed by serum iron levels. Iron deficiency may be due
to blood loss, dietary deficiency, or increased demand due to pregnancy or lactation.
As red blood cells age, the body breaks them down and the iron is released. This iron
is reused for the production of new blood cells. A small amount of iron is lost daily
through the GI tract, necessitating dietary replacement. When RBCs are produced
without a sufficient amount of iron, the cells are smaller and paler than usual.

SIGNS AND SYMPTOMS

• Weakness due to anemia and tissue hypoxia
• Pallor due to decreased amount of oxygen getting to surface tissues
• Fatigue due to anemia and hypoxemia
• Koilonychia—thin, concave nails raised at edges, also called spoon nails
• Tachycardia and tachypnea on exertion due to increased demand for oxygen



TREATMENT

Iron replacement therapy is continued to correct the deficiency and replace the lost
stores of iron in the body. The typical timeframe for oral therapy is to continue for
3 to 6 months after the anemia has been corrected. There have been documented
incidents of anaphylactic reactions to iron dextran. Patients new to this treatment
typically have a smaller test dose initially, prior to the initiation of treatments.
• Administer iron to replace what has been lost to return stores to normal levels:
• Oral replacement in split doses (three times a day):
• ferrous sulfate
• ferrous gluconate
• ferrous fumarate

• Parenteral iron replacement for those who cannot tolerate or do not respond
to oral therapy, have gastrointestinal illness, or continued bleeding:
• iron dextran given deep IM or IV
• iron sodium gluconate given IV
• iron sucrose complex given IV
• IM injection of iron using Z-track method.
• Increase dietary intake of iron.


NURSING DIAGNOSES

• Imbalanced nutrition, less than what body requires
• Activity intolerance

NURSING INTERVENTION

• Monitor intake and output.
• Monitor vital signs for tachycardia or tachypnea.
• Monitor for reactions to parenteral iron therapy.
• Explain to the patient:
• Check for bleeding.
• Increase iron in diet.
• Teach dietary sources of iron.